Definition & Overview
A proctoscopy is an endoscopic medical procedure used to examine the anal canal, rectum, and the sigmoid colon. It plays a key role in the treatment and management of rectal and anal diseases and is considered one of the simplest and most commonly performed diagnostic procedures, along with proctosigmoidoscopy and lower intestinal endoscopy.
The procedure is performed using a proctoscope, a rigid and hollow metal or plastic scope around 13 cm in length, which makes it a bit longer than the anoscope (~10 cm in length) and the rectoscope (~25 cm in length). The tube has an attached small light source that provides illumination while an attached camera sends visual images to a computer monitor for the doctor or technician to examine.
Who Should Undergo and Expected Results
Proctoscopy can be recommended if the following conditions are suspected:
- Anal fissures
- Rectal polyps
- Benign rectal tumour
- Rectal or anal cancer
- Inflammatory diseases affecting the anal region
- Amoebiasis or intestinal parasitic infection
A proctoscopy is expected to provide additional information and visual evidence to confirm a diagnosis. Based on studies, the procedure can detect up to 70% of all abnormalities affecting the entire 5 feet length of the large intestine. Thus, many experts believe that the procedure should be a physician’s first step when confronted with a diagnostic problem involving the large intestine. Compared to a roentgenogram, which requires fasting and purgation, a proctoscopy is not only simpler but its results are also easier to interpret.
If necessary and when possible, proctoscopy can also be used to perform certain treatments or diagnostic measures, such as:
- Rectal biopsy, or the removal of a piece of tissue from an abnormal growth or polyp for further analysis
- Polypectomy, or the removal of a polyp
- Sclerotherapy, for the treatment of haemorrhoids
- Rubber-band ligature, for the treatment of haemorrhoids
Depending on the results of proctoscopy, additional procedures may be recommended to rule out other medical conditions and make a diagnosis.
How is the Procedure Performed?
A proctoscopy is performed using a thin hollow tube called a proctoscope, which is available in non-disposable metal types as well as disposable plastic types. One of the most commonly used is Kelly’s rectal speculum, a non-disposable type named after Howard Atwood Kelly, an American gynaecologist.
To perform proctoscopy, the doctor or technician first examines the anal region for any abnormalities while the patient is lying down on his left side with his knees pulled up towards his chest. The doctor then lubricates the proctoscope before slowly inserting it into the anal canal and gradually pushing it into the rectum. If necessary, the doctor will inject air through the proctoscope to improve visuals during the procedure, which typically lasts for around 15 minutes or even less.
No preparation is required before a proctoscopy, except for an enema to clean the bowel, which allows the doctor to see more clearly during the proctoscopy. If the patient is taking blood-thinning medications, he is advised to consult his physician about the proctoscopy to determine whether he needs to stop taking the said drugs.
The procedure can be performed with or without sedatives, depending on the patient’s pain tolerance level and the doctor’s recommendations. If sedatives are used, the patient will have to stay at the hospital until the effects of the sedatives wear off. If no sedatives were used, the patient is allowed to go home immediately after the procedure.
It is normal for patients to feel mild to moderate discomfort while the procedure is being performed, especially as the proctoscope is inserted further into the rectal canal. The use of more modern fibre optic proctoscopes, however, significantly reduces the discomfort that accompanies a proctoscopy.
Possible Risks and Complications
A proctoscopy is a safe and simple procedure with minimal risks including allergic reactions to the sedatives used, if any, and the possibility of rectal bleeding. The risk of bleeding is higher when the patient already experienced rectal bleeding prior to the test and when a biopsy was performed. However, bleeding is usually minimal and resolves without treatment.
Sorensen HT., Ejlersen E., et al. “Overall use of proctoscopy in general practice and possible relation to the stage of rectal cancer.” Oxford Journals. 9(2): 145-148. http://fampra.oxfordjournals.org/content/9/2/145.abstract
Schroder S. “Value of proctoscopy in diagnosis of amebias.” The American Journal of Medicine. 1948 Aug; 5(2): 319. http://www.amjmed.com/article/0002-9343(48)90080-1/abstract